Infertility, Reproductive Rights, and Social Justice Debates

The Ancient Stigma of Childlessness and Modern Contradictions

The problem is as old as the New Testament: in it, Mary's cousin Elizabeth, an aged woman, had never had a child. Miraculously, she conceived and gave birth to John, later known as John the Baptist. At least two thousand years ago, the fact of being childless was looked upon by society as something to be lamented, and the childless couple was a family unit to be pitied.

Nothing much has changed, if the media attention given to infertility and reproductive rights discussions is any indication. In a world that simultaneously worries about overpopulation, it seems a contradiction at best to be concerned about not being able to conceive children; in an era when birth control products are widely advertised on television, it would appear an anomaly. However, it is an anomaly that stirs violent passions, particularly among those who consider the ability to bear children an inalienable right, much like those granted in the U.S. Constitution.

As of 1995, the National Center for Health Statistics reported that there were 6.1 million women between the ages of 15 and 44 who were experiencing an "impaired ability to have children" (NCHS Web site, 2005). In addition, they reported 2.1 million married couples unable to have children, and 9.3 million women using infertility services (NCHS Web site, 2005).

Feminism, Pregnancy Discrimination, and the Infertility-as-Disability Debate

There was a time when such statistics might not even have been kept. Before the women's movement, women were considered to be disabled when they were pregnant — disabled in a shameful way, and their "condition" was never spoken of except in hushed tones in mixed company, if it was referred to at all. In the rare cases of women working while pregnant, they were likely to be fired; women's function was considered to be childbearing, but only — at least in middle-class families — within the confines of the home (Kaminer, 2000).

Feminists finally succeeded in outlawing pregnancy discrimination in the workplace in the 1970s. They were so successful in shifting the perception of pregnancy away from disability that today, women often claim to be disabled by infertility (Kaminer, 2000). It is tempting to wonder whether such women will demand blue "wheelchair" tags for their cars and full ADA entitlements. Indeed, Kaminer notes that it is ironic how demands for expanded health care coverage have encouraged some to seek to define infertility as a disability under federal law — which would make treatment for infertility mandatory in health care plans, even if it stopped short of offering infertile women preferred parking status. (One might also wonder, if that were accomplished, whether men who are one half of an infertile couple would also be able to lay claim to parking stickers. While this is admittedly tongue-in-cheek, given the scope of federal mandates, it might not be as far-fetched as it sounds.)

Beyond the humor, however, there are genuinely divisive aspects to the problem. Infertility is often considered not only a woman's problem, but one exacerbated by the decision of professional women to delay childbearing to the point that conception becomes biologically difficult. These women demand expensive infertility treatments — treatments arguably unavailable to younger women who have not delayed childbearing yet are nonetheless having trouble conceiving. In this way, the medical problem becomes a sociological one as well, tearing at the fabric of society and fraying the fabric of feminist solidarity built during the 1970s.

Moreover, infertility is relative, defined by society as much as by medicine. In the United States, epidemiologists define infertility as one year of unfruitful, unprotected intercourse (Kaminer, 2000). And yet, many people are simply unlucky or have failed to engage in intercourse during the fertile intervals within that year. In the thirteenth month, they may conceive. It is reasonable to wonder why infertility is measured by epidemiologists at all; it will not kill you, it does not impair independence, and mental health is not at risk for many who successfully adapt.

Legal Precedent: Bragdon v. Abbott and the ADA

Adding fuel to the controversy, a 1998 Supreme Court decision strengthened the case of infertility rights proponents by holding, in Bragdon v. Abbott, that a woman who was an asymptomatic HIV carrier was covered by the Americans with Disabilities Act (ADA) because her disease effectively prevented her from having children. This was possible because the ADA defines a disability as any impairment that substantially limits a person's ability to perform one or more major life activities (Kaminer, 2000).

Those who believe the fertility rights movement has gone too far contend that it is ludicrous to classify the inability to bear children — for whatever reason — alongside conditions that render people unable to walk, see, hear, or breathe without assistance. That faction argues that while the inability to bear children may be personally troubling to those it affects, it does not produce the economic discrimination and social isolation that "true" disabilities engender, and therefore should not be classified with them or receive equivalent funding (Kaminer, 2000).

In fact, Kaminer notes that for women, childlessness remains a professional advantage; it might also be considered an economic advantage, given the cost of childcare — a benefit less likely to be provided to non-professional women than to professional women, making childrearing considerably more expensive for lower-income women. Not only is childbearing a professional disadvantage for women, but for those least able to afford children, it is also an added financial burden. Viewed this way, concern about infertility would appear to be, as Kaminer contends, a "disease" of the wealthier class of women. If that is so, it can hardly be worthy of ADA concern; it takes on the character of elective cosmetic surgery.

References

Duin, J. (1999). Reckless reproduction? Insight on the News, 15(26), 41.

Infertility. (2005). National Center for Health Statistics. Retrieved July 7, 2005, from http://www.cdc.gov/nchs/fastats/fertile.htm

Kaminer, W. (2000). Reproductive entitlement. The American Prospect, 11(10), 14.

Platell, A. (2004). Nobody has the right to be a mother: Amanda Platell explains why fertility treatment is not for her. New Statesman, 133(4673), 29.

Reproductive tourism. (2004). The Wilson Quarterly, 28(2), 103.

Taylor, R. (1999). Reproductive medicine and ethics. Free Inquiry, 19(2), 55+.